FACTS ON: The Effects of Alcohol

By Gail Gleason Milgram, Ed.D

Ethyl alcohol, or ethanol, is a clear, thin, odorless liquid that
boils at 173 degrees F (78 degrees C). It can burn, it can be mixed with
water in any proportion, and it is one of the few alcohols that is made
for consumption; however, it never exists full-strength in any alcoholic
beverage. Ethyl alcohol is the subject of this fact sheet, and from now
on will be referred to simply as “alcohol”.

Alcohol is produced during a natural process called fermentation,
which occurs when yeast, a microscopic plant that floats freely in the
air, reacts with the sugar in fruit or vegetable juice, creating alcohol
and releasing carbon dioxide. The process stops naturally when about 11%
to 14% of the juice is alcohol; the product of this fermentation is wine.
A similar process is used to make beer.

Distillation is the process used to make beverages with a higher
alcohol content. In this process the fermented liquid is heated until it
vaporizes, and then the vapor is cooled until it condenses into a liquid
again. Distilled alcoholic beverages (e.g., whiskey, gin, vodka, and rum)
contain 40% to 50% alcohol. They are sometimes referred to as “spirits”
or “hard liquor”.

When someone drinks an alcoholic beverage it flows into the stomach.
While it is in the stomach, the drinker does not feel the effects of the
alcohol, but alcohol does not remain in the stomach very long. Some of it
is absorbed through the stomach walls into the bloodstream, but most
alcohol passes into the small intestine and then into the bloodstream,
and this circulates throughout the body. Once alcohol is in the
bloodstream it reaches the brain and the drinker begins to feel its
effects. The reason that a large person does not feel the effects of a
drink as quickly as a small person is because the large person has more
blood and other body fluids and will not have as high a level of alcohol
in the blood after drinking the same amount of alcohol.

The body disposes of alcohol in two ways: elimination and oxidation.
Only about 10% of the alcohol in the body leaves by elimination from the
lungs and kidneys. About 90% of the alcohol leaves by oxidation. The
liver plays a major role in the body’s oxidation of alcohol. When alcohol
enters the liver, some of it is changed to a chemical called acetaldehyde
. When acetaldehyde is combined with oxygen, acetic acid is formed. When
the acetic acid is further combined with oxygen, carbon dioxide and water
are formed.

The oxidation of alcohol produces calories. One ounce of pure alcohol
contains about 163 calories (or about 105 calories in a 1 12 ounce glass
of whiskey or gin), but it does not contain vitamins or other physically
beneficial nutrients. The liver can oxidize only a certain amount of
alcohol each minute; the oxidation rate of alcohol in a person weighing
150 pounds, for example, is about 7 grams of alcohol per hour. This is
equivalent to about 34 of an ounce of distilled spirits, 2 12 ounces of
wine, or 7 34 to 8 ounces of beer per hour. If a person drank no more
than 34 of an ounce of whiskey or half a bottle of beer every hour, the
alcohol would never accumulate in the body, the person would feel little
of the effects of the alcohol, and would not become intoxicated.

Oxidation continues until all the alcohol has left the body. Since the
body can remove only a small amount of alcohol at a time, those who
choose to drink are advised to drink slowly.

The effects of alcohol on an individual depend on a variety of
factors. These include:

How one feels before drinking: If a person is upset and tense, very
excited, sad, nervous, or even extremely happy, he or she may tend to
gulp drinks and actually consume more alcohol than planned.

What the drinker expects alcohol to do: Some people expect a drink to
help them feel relaxed, happy, angry or sad. Quite naturally, these
feelings can be produced by the drink; how you want to feel helps you
feel that way.

How much one drinks: A person who has one drink during dinner is not
likely to feel the effects of alcohol. But having six drinks before and
during dinner means the individual might not make it through dessert.

How long one takes to drink: This is a critical factor: four drinks in
one hour will have an obvious effect on the drinker, but the same four
drinks over a four-hour period will probably have a very slight, if any,
effect. Type of alcoholic beverage: Some beverages have more alcohol in
them than others. Beer has about 4.5% alcohol, “table wines” average from
11% to 14%, “fortified” or “dessert wines” (such as sherry or port) have
16% to 20%, and distilled spirits range from 40% to 50%. However, in
normal size, each drink (i.e., 12 ounces of beer, 5 ounces of wine, and 1
1/2 ounces of distilled spirits) contains approximately the same amount
of alcohol.

Size of the drinker: Because of the way alcohol circulates in the
body, the size of the drinker also relates to the effects of alcohol. A
person weighing 220 pounds will not feel the effects of a drink as much
as a person weighing 120 pounds.

Food in the stomach: The alcohol consumed does not affect the drinker
until it has been absorbed into the bloodstream. Food in the stomach
slows the alcohol’s absorption, so that a person who has a drink after
eating a meal will feel less effect than a person who has a drink on an
empty stomach.

Experience in using alcoholic beverages: Someone drinking a glass of
wine may experience light-headedness the first time, but will probably
not experience that effect on subsequent occasions. However, most
individuals who drink know what to expect from various amounts of alcohol
because of their prior experience with drinking.

Alcohol acts directly on the brain, and affects its ability to work.
The effects of alcohol on the brain are quite complex, but alcohol is
usually classified as a depressant. Judgment is the first function of the
brain to be affected; the ability to think and make decisions becomes
impaired. As more alcohol is consumed, the motor functions of the body
are affected.

The effects of alcohol are directly related to the concentration
(percentage) of alcohol in the blood; however, the effects vary among
individuals and even in the same individual at different times. In the
following description, the blood alcohol concentrations (BAC) are those
that would probably be found in a person weighing about 150 pounds:

At a BAC of 0.03% (after about one cocktail, one glass of wine, or one
bottle of beer), the drinker will feel relaxed and experience a slight
feeling of exhilaration.

At 0.06% (after two cocktails, two glasses of wine, or two bottles of
beer), the drinker will experience a feeling of warmth and relaxation;
there will be a decrease of fine motor skills and he or she will be less
concerned with minor irritations.

At 0.09% (after three cocktails, three glasses of wine, or three
bottles of beer), reaction time will be slowed, muscle control will be
poor, speech will be slurred and the legs will feel wobbly.

At 0.12% (after four cocktails, four glasses of wine, or four bottles
of beer), his or her judgment will be clouded, inhibitions and
self-restraint lessened, and the ability to reason and make logical
decisions will be impaired.

At 0.15% (after five cocktails, five glasses of wine, or five bottles
of beer), vision will be blurred, speech unclear, walking will be
unsteady, and coordination impaired. At 0.18% (after six cocktails, six
glasses of wine, or six bottles of beer), all of the drinker’s behavior
will be impaired, and he or she will find it difficult to stay awake.

At a BAC of about 0.30% alcohol in the blood (after 10 to 12 drinks),
the drinker will be in a semi-stupor or deep sleep. Most people are not
able to stay awake to reach a BAC higher than 0.30%.

If the BAC reaches 0.50% the drinker is in a deep coma and in danger
of death. As the alcohol level reaches 1% in the blood, the breathing
center in the brain becomes paralyzed and death occurs.

In many states a BAC of 0.10% is considered legal evidence that a
driver is intoxicated; some states use a BAC of 0.08%. In some European
countries the legal BAC is as low as 0.05%.

Suggestions for Further Reading

Johnston, L.D., O’Malley, P.M., & Bachman, J.G. (1993). National
survey results on drug use from the monitoring the future study 1975-1992
Rockville, MD: National Institute on Drug Abuse.

Milgram, G. G. (1990). The facts about drinking: Coping with alcohol
use, abuse, and alcoholis. Mt. Vernon, NY: Consumers Union.

National Institute on Alcohol Abuse and Alcoholism. (1993). Eighth
special report to the U.S. Congress on alcohol and health from the
Secretary of Health and Human Services. (NIH publication no. 94-3699).
Rockville, MD: National Institutes of Health.

———————————————————————-

National Institute on Alcohol Abuse and Alcoholism

No. 5 PH 270 August 1989

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Alcohol Withdrawal Syndrome

The alcohol withdrawal syndrome is a cluster of symptoms observed in
persons who stop drinking alcohol following continuous and heavy
consumption. Milder forms of the syndrome include tremulousness,
seizures, and hallucinations, typically occurring within 6-48 hours after
the last drink. A more serious syndrome, delirium tremens (DTs), involves
profound confusion, hallucinations, and severe autonomic nervous system
overactivity, typically beginning between 48 and 96 hours after the last
drink (Victor 1983). Estimates vary on the incidence of serious
consequences of alcohol withdrawal. Regardless of actual incidence,
recent evidence suggests that it may be important to treat everyone who
is suffering from alcohol withdrawal.

In a classic study that has shaped our understanding of alcohol
withdrawal for many years, Isbell et al. (1955) found that
alcohol-related seizures occur only after stopping heavy drinking. In a
recent study that looked primarily at seizures, Ng et al. (1988)
challenged Isbell’s concept and reported that the risk of first seizure
is related to current alcohol use rather than to withdrawal. They
concluded, based on self-reports given retrospectively by seizure
patients, that the relationship of alcohol use to seizures is causal and
dose-dependent. However, emerging neurophysiological findings lend
support to Isbell’s interpretation of withdrawal.

In the central nervous system, ethanol (in concentrations high enough
to intoxicate humans) interferes with the processes that tell certain
nerve cells to activate or become excited (Hoffman et al. 1989; Lovinger
et al. 1989). It also enhances those processes that tell certain nerve
cells to be restrained (Suzdak et al. 1986). Thus, ethanol acts as a
nonspecific biochemical inhibitor of activity in the central nervous
system. During withdrawal, a person’s central nervous system experiences
a reversal of this effect: Excitatory processes are enhanced while
inhibitory processes are reduced (Morrow et al. 1988). Such changes can
result in overactivation of the central nervous system when alcohol is
withdrawn.

Clinical researchers have measured this overactivation in patients
(Linnoila et al. 1987). Even patients with moderately severe alcohol
withdrawal can experience sympathetic nervous system overactivity and
increased production of the adrenal hormones cortisol and norepinephrine.
Both of these hormones can be toxic to nerve cells. Moreover, cortisol
can specifically damage neurons in the hippocampus (Sapolsky et al.
1986)–a part of the brain that is thought to be particularly important
for memory and control of affective states. Thus, repeated untreated
alcohol withdrawals may lead to direct damage to the hippocampus.

Ballenger and Post (1978) did a retrospective chart review that led
them to postulate that repeated inadequately treated withdrawals could
produce future withdrawals of increased severity. These authors suggested
that this phenomenon may be analogous to kindling as described in the
animal literature. In kindling, repeated, weak (subthreshold), electrical
or pharmacological stimulation of certain parts of the central nervous
system leads to increased sensitivity; an animal eventually exhibits
behavioral changes (including seizures) that are more severe on each
occasion. The implication is that repeated untreated withdrawals from
alcohol have a cumulative effect and create more serious future
withdrawals. Only a minority of chronic alcoholics develop a seizure
disorder, so an inherited vulnerability may be involved. Many
investigators (e.g., Linnoila et al. 1987) now believe that chronic
alcoholics who cannot maintain abstinence should receive pharm acotherapy
to control withdrawal symptoms, thereby reducing the potential for
further seizures and brain damage.

In a recent review of pharmacological treatments for alcohol
intoxication, withdrawal, and dependence, Liskow and Goodwin (1987)
concluded that the drugs of choice for treating withdrawal are the
benzodiazepines–e.g., the longer-acting benzodiazepines chlordiazepoxide
(Librium) and diazepam (Valium) or the shorter-acting benzodiazepines
oxazepam (Serax) and lorazepam (Ativan).

Physicians traditionally have used benzodiazepines by administering
decreasing doses over the period of alcohol withdrawal. Rosenbloom (1988)
recommends this approach, suggesting the use of intermediate half-life
benzodiazepines (such as lorazepam), or even shorter half-life drugs
(such as midazolam), because these drugs do not linger in the system and
allow for doses to be easily titrated to the parent’s response. However,
Sellers et al. (1983) introduced a different approach. At the start of
treatment, doses of diazepam are given every 1 to 2 hours until
withdrawal symptoms abate. Because diazepam has a long half-life and
produces a psychoactive metabolite (desmethyldiazepam) with an even
longer half-life, there is usually no need for further medication. This
strategy, called “loading dose,” simplifies treatment, protects against
seizures, and eliminates possible reinforcement of drug-seeking behavior
in parents who otherwise might receive additional medication for relief
of symptoms.

Other agents, such as the beta-blocker propranolol (Sellers et al.
1977), the beta-blocker atenolol in combination with oxazepam (Kraus et
al. 1985), and the alpha-2-adrenoreceptor agonist clonidine (Manhem et
al. 1985; Robinson et al. 1989), have been tested and shown to alleviate
some symptoms of the withdrawal syndrome, but there is no clear evidence
of their efficacy in preventing seizures (Liskow and Goodwin 1987).
Potential drugs for future use are calcium channel blockers (Koppi et al.
1987) and carbamazepine, which are now in the early stages of evaluation
(Butler & Messiha 1986).

Most clinicians use medications to diminish the symptoms of alcohol
withdrawal. However, Whitfield et al. (1978) reported success with
nondrug detoxification of a group of ambulatory patients with
uncomplicated alcoholism. The treatment consisted of screening and
providing extensive social support during withdrawal. The authors
concluded that nondrug detoxification offers a reduced need for medical
staff, a shortened detoxification period, and no sedative interference
with a patient’s alertness for participating in an alcohol treatment
program.

Several researchers have developed scales for assessing the severity
of the alcohol withdrawal syndrome: the Total Severity Assessment and
Selected Severity Assessment (Gross et al. 1973), the Abstinence Symptom
Evaluation Scale (Knott et al. 1981), and the Clinical Institute
Withdrawal Assessment Scale [CIWA] (Shaw et al. 1981) Originally
developed as research tools for studying treatment efficacy, such scales
are now finding clinical use. Foy et al. (1988) demonstrated that a
modified version of the CIWA can assist in guiding treatment and
predicting patients at risk for severe alcohol withdrawal. Such scales
also may be helpful when monitoring the adequacy of a loading dose of
medication. However, rating procedures are not infallible, and an
occasional patient will have a more severe reaction than the scale
predicts. Rating procedures cannot replace the clinical judgment of
medical staff.

One final point deserves mention. A recent study by Hayashida et al.
(1989) compared outpatient with inpatient detoxification. The research
concluded that outpatient medical detoxification is “an effective, safe,
and low-cost treatment for patients with mild-to-moderate symptoms of
alcohol withdrawal.” However, the data from this study indicate that
inpatient detoxification was more effective than outpatient
detoxification: At the 6-month followup those treated as inpatients
reported significantly greater improvement in their drinking behavior,
despite having been measured as more impaired than the outpatient group
at the time of admission. This point is not emphasized in the report.
Whereas outpatient detoxification may be cheaper for some alcoholics, it
is not clear to what extent serious comorbidities, which may be
undetected outside a hospital setting, may lead to more severe and
expensive problems later.

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Alcohol Withdrawal Syndrome– A Commentary by
NIAAA Director Enoch Gordis, M.D.

A variety of techniques exist for managing alcohol withdrawal, some
that involve pharmacotherapy with sedatives and some that do not. Based
on current literature, it appears that it is probably safe to treat mild
withdrawal without drugs. However, research on treating alcohol
withdrawal is just beginning to accumulate. Recent research findings show
a potential for central nervous system damage to patients who experience
repeated withdrawals and suggest that all patients exhibiting alcohol
withdrawal symptoms receive pharmacotherapy. As evidence increases, it
may well be that pharmacotherapy becomes the recommended choice in all
withdrawal cases. Therefore, it is vital that clinicians keep abreast of
the literature to ensure that their patients receive the most up-to-date
care.

When using sedatives to treat alcohol withdrawal, understanding the
relative advantages and disadvantages of different drug administration
techniques is important. Administering an initial dose of a long-acting
benzodiazepine, like diazepam, with repeated doses every 2 hours until
symptoms subside, then stopping the drug, simplifies treatment and frees
patients and staff to focus on the recovery process, not drug dosage
schedules. However, this method could cause problems if sedation is found
to complicate an existing medical condition, such as chronic obstructive
pulmonary disease, because the drugs, or their metabolites, remain in the
body for several days. On the other hand, by giving repeated doses of a
short-acting benzodiazepine (e.g., oxazepam), probably for several days,
if complications to medical conditions are found, the drugs can be easily
stopped due to their rapid elimination by the body. But this regimen is
less easily managed because medication must be given around the clock,
and it could result in the patient and staff attending to the drug-taking
regimen rather than to recovery.

In deciding which drug administration technique to use for individual
patients, there is no substitute for a thorough medical evaluation. There
is a welcome trend toward using the CIWA and other clinical scales for
measuring withdrawal syndrome severity and for guiding drug treatment
decisions; their use should be encouraged. However, no scaling instrument
is infallible. Withdrawal severity scales should be used to complement,
not replace, a thorough clinical evaluation of the patient’s medical
status.

———————————————————————-

NOTE: The following ERRATA appeared in Alcohol Alert
No. 8. It is shown here for clarity.

ERRATA: Dr. M. Hayashida has notified NIAAA that
Alcohol Alert No. 5, entitled “Alcohol Withdrawal Syndrome,” contained
incorrect information about his study comparing the effectiveness and
costs of inpatient and outpatient detoxification (Hayashida, M.;
Alterman, A.; McLellan, A.; et al. Comparative effectiveness and costs of
inpatient and outpatient detoxification of patients with mild-to-moderate
alcohol withdrawal syndrome. New England Journal of Medicine 320(6):
358-365,1989). The last paragraph of the Alert erroneously reported
that data from the study provide evidence that inpatient detoxification
was more effective than outpatient detoxification. However, an accurate
interpretation of the study would have suggested that some significant
differences were noted between the two groups at a 1-month followup,
favoring inpatient detoxification (a group that was more impaired by some
drinking measures at admission), but that no differences were observed at
a 6-month followup.

———————————————————————-

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service * National Institutes of Health

A New Method for Identifying Problem Drinkers

By Randall Mikkelsen

PHILADELPHIA, Nov 14 (Reuter) – A new method for identifying problem
drinkers can lead to earlier, more effective treatment and could double
the number of people receiving help, researchers said on Thursday.
11-14-96

The method, tested with success in Cambridge, Ontario, relies on
indirect questioning to identify potential drinking problems and a modest
level of “lifestyle counseling” to limit alcohol use.

“We could markedly reduce the cost of alcohol abuse in the U.S.A. by
implementing a very simple system like the one that we’ve applied,” said
Yedi Israel, a professor at Thomas Jefferson University’s medical school
and lead author of a research report on the method. “If you are a
(alcohol) dependent person, it’s like a declaration of independence.”

In the United States, where only about one million of an estimated 10
million problem drinkers are receiving treatment, another one million
people yearly could be helped through the new screening and treatment
techniques, Israel said.

The report is to be published in the Nov. 15 issue of “Alcoholism:
Clinical and Experimental Research.” It was based on a study of 15,000
people in Cambridge, a city of 90,000.

The method begins with a series of four questions asked of patients in
their doctors’ waiting rooms on whether they have had any injuries or
fights in the previous five years. This is based on research showing
about half of all injuries are alcohol-related and other research showing
both doctors and patients resist screening techniques in which every
patient is asked directly about alcohol abuse, Israel said.

In addition, he said, doctors often are not trained in treating
alcohol problems and share with their patients an aversion, because of
the stigma, to referring people to alcohol-treatment professionals until
it is too late.

“We have not had systems that allow intervention early on where the
patient — the problem drinker — doesn’t have to define herself or
himself as alcoholic,” he said. “Alcoholism is not a disease in the early
stages but it ends up being a disease at the very end, where the person
doesn’t have absolute control over drinking.”

Patients in the study were asked in the waiting-room questionnaire
whether they had broken or dislocated any bones or joints, been injured
in a traffic accident, received a head injury or been in a fight or
assault. Those who answered “yes” to two or more questions — about one
in seven — were then asked by their doctors about their alcohol
consumption and any alcohol-related problems.

About 3.5 percent of the total number of patients were identified as
problem drinkers. In this way, doctors were able to identify 70 percent
of the problem drinkers that could be expected in a group of this size,
the study said.

Patients who qualified for treatment and accepted were then given
either three hours of counseling over a year with a trained nurse or
simple advice to reduce their drinking.

Those who received the counseling, which helped drinkers to identify
and control situations in which they were likely to drink, showed
significant declines in alcohol consumption and related problems. Those
who received simple advice reported that they drank less often but that
physical and social problems related to drinking did not decline.

Israel said the screening method is inexpensive, less than $1 per
patient, and predicted its use would increase. It will be implemented in
the Philadelphia area though the Jefferson health system and he has been
teaching it to a New York health maintenance organization with 22 million
members, he said.

15:47 11-14-96

Dietary Guidelines for Alcohol

Based on the Dietary Guidelines for Americans set by the Department of
Health and Human Services and the Department of Agriculture, CSAP has
developed the following guidelines on alcohol consumption.

Adults who are considering drinking alcoholic beverages should have
only low-risk drinking as a goal, if they choose to drink. The lowest
risk is not to drink, which should always be acceptable. Adult women who
elect to drink should limit their consumption to no more than one drink
per day. Men who elect to drink should limit their consumption to no more
than two drinks per day. Underage youth should not drink.

These circumstances place drinkers at high risk for health, social,
and/or legal consequences:

If underage;
If pregnant, nursing, or trying to conceive;
If driving or engaging in other activities that require attention,
judgment or skill;
If taking medication that interacts with alcohol;
If recovering from alcohol or other drug dependence;
If drinking to intoxication;
If drinking cannot be done in moderation.

Although not specifically addressed by the guideline, alcohol use also
is contrindicated for people with certain medical conditions such as
peptic ulcer. The existence of spearate guidelines for men and women
reflects research findings that women become more intoxicated than men a
the equivalent dos of alcohol due to the size of their bodies in
relationship to men.

Reference
Dietary Guidelines for Americans, Department of Health and Human
Services and Department of Agriculture (1992)

READING LIST ON THE ADDICTIONS

Selected Bibliography Last Updated: 07/96

This bibliography presents a selection of the ARF Library materials on
the topic of addictions. Please consult your workplace/community
libraries and information services to obtain these materials.

Baugh, James R. Recovering From Addiction: Guided Steps Through
the Healing Process. New York: Insight Books. RC 533 .B28 1990

Breeden, Joann E. Love, Hope and Recovery: Healing the Pain of
Addiction. Nevada City, CA: Blue Dolphin Publishing, Inc., 1993. RC
564 .B734 1994

Browne Miller, Angela. Gestalting Addiction: The Addiction-Focused
Group Therapy of Dr. Richard Louis Miller. Norwood, NJ: Ablex
Publishing Corp., 1993. RC 564 .B775 1993

Browne Miller, Angela. Transcending Addiction and Other
Afflictions: Lifehealing. Norwood, NJ: Ablex Publishing Corp., 1993.
RC 533 .B76 1993

Burns, John. The Answer to Addiction: The Path to Recovery From
Alcohol, Drug, Food, And Sexual Dependencies. New York: Crossroad.
RC 564 .B8723 1990

Carey, Sylvia. Jolted Sober: Getting to the Moment of Clarity in
the Recovery From Addiction. Los Angeles, CA: Lowell House. RC 564
.C368 1989

Corey, Michael A. Kicking the Drug Habit: A Comprehensive
Self-Help Guide to Understanding the Drug Problem and Overcoming
Addiction. Springfield, Ill.: Charles C. Thomas. RC 564 .C684
1989

Cretchen, Dorothy. Steering Clear: Helping Your Child Through the
High-Risk Drug Years. Minneapolis: Winston Press, 1982. 110p. HV
5824 .Y68 C73 1982

Daley, Dennis C. Kicking Addictive Habits Once and for All: A
Relapse-Prevention Guide. Lexington, MA: D.C. Heath and Co., 1991.
RC533 .D34 1991

Davies, John Booth. The Myth of Addiction. New York: Harwood
Academic Publishers, 1992. RC 566 .D37 1992

Ditzler, James, Joyce Ditzler and Celia Haddon. Coming Off
Drugs. London: MacMillan, 1986. 183p. RC 564 .D57 1986

Dixon, Annas. Dealing With Drugs. London: BBC Books, 1987.
208p. HV 5801 .D425 1987

The Dual Disorders Recovery Book: A Twelve Step Program for Those
of us With Addiction and an Emotional or Psychiatric Illness: What we
Used to be Like, What Happened, and What we are Like Now. Center
City, MN: Hazelden, 1993. RC 564 .D836 1993

Engs, Ruth. Alcohol and Other Drugs: Self Responsibility.
Bloomington, Indiana: Tichenor Pub., 1987. 387p. HV 5801 .E65 1987

Finnegan, John. Recovery From Addiction: A Comprehensive
Understanding of Substance Abuse With Nutritional Therapies for
Recovering Addicts and Co-Dependents. Berkeley, CA: Celestial Arts,
1990. RC 564 .F56 1990

Geide, Ray. Beyond Addiction: A Step-By-Step Guide to the
Spiritual Principles of Addiction and Recovery. Dexter, KS: Dexter
Publishing. RC 533 .G44 1991

Geller, Anne and M.J. Territo. Restore Your Life: A Living Plan
for Sober People. New York: Bantam, 1992. RC 564 .G368 1992

Goodwin, Donald. Alcoholism: The Facts. Oxford, UK: Oxford
University Press, 1994. RC 565 .G638 1994

Grof, Christina. The Thirst for Wholeness: Attachment, Addiction
and the Spiritual Path. San Francisco, CA: Harper, 1993. RC 564 .G76
1993

Hodgson, Ray, and Peter Miller. Selfwatching: Addictions, Habits,
Compulsions: What to Do About Them. New York: Facts on File, 1982.
224p. RC 564 .H6 1982

Jill, S. and Brian S. Learning to Live Again: A Guide for the
Recovering Addict. Bradenton, FL: Tab Books, 1991. RC 564.29 .J55
1991

Kearney, Robert J. Within the Wall of Denial: Conquering Addictive
Behaviors. New York: W.W. Norton & Co., 1996. RC 564 .K368
1996

Kinney, Jean and Gwen Leaton. Loosening the Grip: A handbook of
Alcohol Information. St. Louis, MO: Mosby-Year Book, Inc., 1991. HV
5035 .K566 1991

Krivanek, Jara A. Addictions. Sydney; Boston: Allen &
Unwin. HV 5822 .H4 K74 1988

Lawson, John. Friends You Can Drop: Alcohol and Drugs.
Boston: Quinlan Press, 1986. 214p. HV 5060 .L374 1986

Luciani, Joseph J. Healing Your Habits: Introducing Directed
Imagination, a Successful Technique for Overcoming Addictive
Problems. San Diego, CA: LuraMedia, 1990. RC 533 .L83 1990

Mann, Marty. Marty Mann’s New Primer on Alcoholism: How People
Drink, How to Recognize Alcoholics, and What to Do About Them. New
York: Holt, Rinehart Winston, 1981. 239p. HV 5035 .M36 1981

Michaelson, Peter. Secret Attachments: Exposing the Roots of
Addictions and Compulsions. Naples, FL: Prospect Books, 1993. RC 533
.M33 1993

Mumey, Jack. The Joy of Being Sober. Chicago:
Contemporarybooks, 1984. 214p. HV 5275 .M85 1984

O’Brien, Robert et al. The Encyclopedia of Drug Abuse. New
York: Facts on File, Inc., 1992. HV 5804 .O24 1992

Peele, Stanton. Diseasing of America: Addiction Treatment Out of
Control. Lexington, Mass.: Lexington Books, 1989. RC 564 .P424
1989

Peele, Stanton. The meaning of addiction: compulsive experience and
its interpretation. Lexington, Mass.: Lexington Books, 1985. RC 564. P45
1985.

Peele, Stanton. The Truth About Addiction and Recovery. New
York: Simon & Schuster, 1992. RC 564 .P439 1992

Peele, Stanton. Visions of addiction: major contemporary
perspectives on addiction and alcoholism. Lexington, Mass: Lexington
Books, 1988. HV 5801. V53 1988.

Plagenhoef, Richard L. and Carol Adler. Why am I Still Addicted?:
A Holistic Approach to Recovery. Blue Ridge Summit, PA: TAB Books,
1992. RC 564 .P53 1992

Pleshette, Janet. Overcoming Addictions. Northamptonshire,
UK: Thorsons. RC 564 .P63 1989

Podsadowski, Alan. Recovery From Addiction: A Guidebook for the
Journey. North Vancouver, BC: West Coast Alternatives Society, 1993.
RC 564 .R4285 1993

Preston, Andrew and Andy Malinowski. The Detox Handbook: A Users
Guide to Getting Off Opiates. Dorset, UK: Island Press, 1994. RC 566
.P734 1994

Psychiatry and the Addictions. Abington, UK: Carfax Publishing. RC 533
.P78 1989

Recovering From Addiction: A Guidebook for the Journey. North
Vancouver, B.C.: West Coast Alternatives Society, 1993. RC 564 .R4285
1993

Rogers, Ronald and C. Scott McMillin. The Healing Road: Treating
Addictions in Groups. New York: W.W. Norton & Co. RC 564 .R64
1989

Rosselini, Gayle and Mark Worden. Of Course You’re Anxious:
Healthy Ways to Deal with Worry, Fear, and Stress in Recovery.
Center City, MN: Hazelden, 1990. RC 564 .R667 1990

Sanchez-Craig, Martha. Saying When: How to Quit Drinking or Cut
Down: An ARF Self-Help Book. Toronto: Addiction Research Foundation,
1993. RC 565 .S2627 1993

Schuckit, Marc Alan. Educating Yourself About Alcohol and Drugs: A
People’s Primer. New York: Plenum Press, 1995. RC 564 .S333 1995

Sourcebook of Substance Abuse and Addiction, ed. Lawrence S.
Friedman. Baltimore, MD: Williams & Wilkins, 1996. HV 5801 .S639
1996

The TRY Book: What You Can Do About Alcohol and Drug Abuse: The
Responsibility is Yours. Victoria, B.C.: Alcohol and Drug Program,
1988. HV 5801 .T78 1988

Twerski, Abraham J. Addictive Thinking: Understanding
Self-Deception. Center City, MN: Hazelden, 1990. RC 533 .T93
1990

Tyrer, Peter. How to Stop Taking Tranquillizers: Overcoming Common
Problems. London: Sheldon Press,1986. 96p. RC 568 .T7 T87 1986

Understanding Substance Abuse & Treatment, eds. George
Pratsinak and Robert Alexander. Laurel, MD: American Correctional
Association, 1992. HV 8836.5 .U53 1992

Washton, Arnold M. Step Zero: What to do When You Can’t Fake it
Anymore: Getting to Recovery. Center City, MN: Hazelden, 1991. RC
564 .W374 1991

Washton, Arnold M. Willpower’s Not Enough: Understanding and
Recovering From Addictions of Every Kind. New York: Harper &
Row. RC 533 .W37 1989

Please send your comments and suggestions to:

Addiction Research Foundation Library
33 Russell Street
Toronto, Ontario
Canada M5S 2S1
internet: http://www.isdweb.arf.org

[07/96 addict.bib]

National Institute on Alcohol Abuse and Alcoholism

No. 12 PH 294 April 1991

———————————————————————-

Assessing Alcoholism

The goal of assessment is to determine personal characteristics that
can influence the treatment of a patient’s alcohol problem. Once a person
has been referred for alcohol treatment, clinicians use assessment
techniques to characterize the problem and to plan treatment (1,2).

Assessment comprises at least four important tasks: 1) to aid in the
formal diagnosis of the patient’s alcohol problem; 2) to establish the
severity of the alcohol problem; 3) to guide treatment planning; and 4)
to define a baseline of the patient’s status, to which his or her future
conditions can be compared (3). Assessment is an ongoing, interactive
process, used to evaluate a patient’s progress and adjust treatment.

Questions answered by assessment include the following: Can withdrawal
be accomplished without medications? Is outpatient treatment appropriate?
If inpatient treatment is desirable, should the setting be psychiatric or
alcohol-specific in nature? What would be an appropriate mix of choices
taken from the variety of therapies? How has the patient’s status changed
during the course of treatment, and what problem areas remain?

A variety of methods are involved in comprehensive patient assessment,
including medical examinations, clinical interviews, and formal
instruments (questionnaires or tests). Each has specific strengths, and
the approaches complement each other as they address the four goals
stated above.

Every patient entering alcoholism treatment presents a unique
combination of medical and psychological characteristics (4-7). Clinical
interviews are valuable, and it is unlikely that there will ever be an
adequate substitute for the experienced and skillful clinician.
Nevertheless, the clinician’s perception and judgment can be enhanced by
the application of formal assessment instruments. Formal instruments
relating to alcohol problems can be used to assess beliefs about the
effects of drinking, levels of alcohol dependence, high-risk drinking
situations, and resources that will aid in recovery. General
psychological instruments can be used to assess personality, cognition,
and neuropsychological characteristics.

Most alcoholism assessment instruments are standardized,
self-administered questionnaires (or tests). These instruments offer
comprehensiveness, consistency, ease of administration, and low cost.
Standardized instruments provide a quantitative scale of alcohol
problems, which can be useful, for example, when attempting to measure
the patient’s current need for treatment and future progress. In
addition, formal instruments tend to be highly valid (they measure
meaningful dimensions of alcoholism) and reliable. They also offer the
clinician norms, by which the patient can be quantitatively compared to
peers. And finally, some patients may place greater confidence in
treatment strategies based on results of standardized tests rather than
on clinical judgment alone.

Clinicians can choose from more than 100 assessment instruments in
constructing a battery of tests tailored to the needs of a particular
patient (see, for example, 8-14). Some instruments are protected by
copyright, but can be obtained and used by paying a small royalty fee.
Many are available free of charge.

To make a formal diagnosis of alcoholism, the clinician might use a
test such as the alcohol section of the Structured Clinical Interview for
DSM-III-R (SCID). The SCID is an extensive interview which must be
administered by a trained clinician. The alcohol section of the SCID can
be administered in about 15 minutes. The SCID reflects the criteria of
the Diagnostic and Statistical Manual of Mental Disorders, Third Edition,
Revised (DSM-III-R) to arrive at a formal diagnosis (15). To make a quick
estimate of the patient’s psychiatric condition, the clinician might
employ a short screening instrument such as the Brief Psychiatric Rating
Scale, or BPRS, which can be administered in about 5 minutes (16). Should
the BPRS suggest possibly severe psychiatric problems, the clinician
might then administer the SCID in its entirety.

To establish the severity of the patient’s alcohol problem, the
clinician might use an instrument such as the Addiction Severity Index,
or ASI (9). The ASI is a structured, 40-minute interview designed to
assess the severity of adjustment problems in seven areas: medical,
legal, psychiatric, drug abuse, alcohol abuse, employment, and family.
The patient answers questions related to the number, extent, and duration
of difficulties in each of these areas.

To help individualize treatment, the clinician might employ an
instrument such as the Alcohol Use Inventory, or AUI (8,17). The AUI
assesses the patient on the basis of three domains: perceived benefits of
drinking, drinking styles, and consequences of drinking. Answers to test
questions in these domains offer helpful suggestions in planning
treatment. A recent version of the AUI comprises 228 questions, and can
be self-administered in 40 to 60 minutes.

While some patients require medication to help them withdraw from
alcohol, many others do quite well with the assistance of social support,
emotional reassurance, and frequent “reality reorientation.” The Clinical
Institute Withdrawal Assessment Scale (CIWA) is an example of an
instrument designed to help clinicians choose the best strategies for
treating the patient’s withdrawal (10,18). The CIWA employs a “check off”
format to uncover signs and symptoms of alcohol withdrawal. Two recent
studies found the CIWA to be helpful in identifying the risk of severe
withdrawal and the need for medication (19,20).

A growing area of interest in alcoholism treatment deals with
identifying emotional, cognitive, and social factors that may precipitate
drinking. If such prompting, or “high risk,” circumstances can be
accurately gauged, treatment can incorporate interventions to teach the
patient the skills to cope with them. The Inventory of Drinking
Situations (21) and the Alcohol Expectancy Questionnaire (22) are
examples of promising instruments being used in this area.

To establish a baseline to which future improvement or deterioration
of the patient may be compared, the clinician might use an instrument
such as the ASI, noted earlier. The measures cited here are examples of a
wide range of instruments, some or all of which might be helpful to
patients.

Many factors must be considered in choosing and employing assessment
instruments to obtain treatment-relevant information (23). In the course
of treatment, the timing and sequencing of tests are important issues.
For example, an early test might help determine if the patient will
require detoxification. Subsequent tests might assess collateral or
contributing psychological problems and suggest interventions and
treatment. Later tests might measure the progress of the patient and
assist in selection of after-care interventions.

Many patients will show cognitive improvement during the few weeks
after drinking has stopped, in which case the clinician must be
especially alert to the timing of tests. In addition, certain limitations
of patients will affect the administration of tests–indeed, the greater
the patient’s impairment, the greater the demand for skill on the part of
the interviewer. The timing and selection of tests depends not only on
the course of the patient’s progress, but also on the needs of the
treatment facility. In choosing and using instruments, administrators and
clinicians consider cost, staff capacity, and their own treatment
models.

Assessment techniques can provide benefits other than those for which
they a re specifically designed. For example, the administration of
instruments can suggest the seriousness and concern for individual
patients of a program. This can encourage patients to stay with or return
to treatment (2,24).

———————————————————————-

Assessing Alcoholism–A Commentary by
NIAAA Director Enoch Gordis, M.D.

Assessment is a valuable tool for alcoholism treatment, and the use of
formal assessment instruments as a standard part of all alcoholism
treatment programs is recommended.

Although formal assessment cannot replace an experienced clinician’s
judgment, standardized tests and questionnaires can supplement clinical
wisdom in important ways. For example, an assessment instrument can
provide important baseline data for measuring individual patient
progress, can aid in making patient/treatment-match decisions, or, in the
press of a busy day, can help prevent clinical staff from omitting things
of importance at intake. Even programs in which only one mix of treatment
is offered can use formal assessments to highlight aspects of a patient’s
life that need the most help. Formal assessment also can provide
standardized patient outcome data that can be used to justify
reimbursement and validate the effectiveness of program components.

The number of programs that currently use any type of assessment
instrument is low, although there are many advantages to such use. Many
programs are concerned that using an assessment instrument may require
extensive staff training or time that should be spent in patient care.
However, all competent programs perform some kind of assessment, whether
it involves a clinician’s initial interview with a patient or the use of
a formal assessment instrument. In many cases, a portion of the time
currently used to conduct initial patient interviews can be devoted to
formal assessment without interfering with patient care. Moreover, the
variety of instruments that are now available permits a program to tailor
assessment to its individual staff and schedule.

———————————————————————-

Representative Sources for Assessment
Instruments:

(1) Marketing Services, Department 898, Addiction Research Foundation,
33 Russell St., Toronto, Ontario, Canada M5S2S1.(2) Psychological
Assessment Resources, Inc., 16204 North Florida Ave., Lutz, FL
33549-6130.(3) Western Psychological Services, 12031 Wilshire Blvd., Los
Angeles, CA 90025-1251.

———————————————————————-

All material contained in the Alcohol Alert is in the public
domain and may be used or reproduced without permission from NIAAA.
Citation of the source is appreciated.

Copies of the Alcohol Alert are available free of charge from
the Scientific Communications Branch, Office of Scientific Affairs,
NIAAA, Willco Building, Suite 409, 6000 Executive Boulevard, Bethesda, MD
20892-7003. Telephone: 301-443-3860.

———————————————————————-

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service * National Institutes of Health

For many people, the facts about alcoholism are not clear. What is
alcoholism, exactly? How does it differ from alcohol abuse? When should a
person seek help for a problem related to his or her drinking? The
National Institute on Alcohol Abuse and Alcoholism (NIAAA) has prepared
this booklet to help individuals and families answer these and other
common questions about alcohol problems. The information below will
explain alcoholism and alcohol abuse, symptoms of each, when and where to
seek help, treatment choices, and additional helpful resources.

———————————————————————-

A Widespread Problem

For most people, alcohol is a pleasant accompaniment to social
activities. Moderate alcohol use–up to two drinks per day for men and
one drink per day for women and older people (A standard drink is one
12-ounce bottle of beer or wine cooler, one 5-ounce glass of wine, or 1.5
ounces of 80-proof distilled spirits) — is not harmful for most adults.
Nonetheless, a substantial number of people have serious trouble with
their drinking. Currently, nearly 14 million Americans–1 in every 13
adults–abuse alcohol or are alcoholic. Several million more adults
engage in risky drinking patterns that could lead to alcohol problems. In
addition, approximately 53 percent of men and women in the United States
report that one or more of their close relatives have a drinking
problem.

The consequences of alcohol misuse are serious–in many cases,
life-threatening. Heavy drinking can increase the risk for certain
cancers, especially those of the liver, esophagus, throat, and larynx
(voice box). It can also cause liver cirrhosis, immune system problems,
brain damage, and harm to the fetus during pregnancy. In addition,
drinking increases the risk of death from automobile crashes,
recreational accidents, and on-the-job accidents and also increases the
likelihood of homicide and suicide. In purely economic terms, alcohol-use
problems cost society approximately $100 billion per year. In human
terms, the costs are incalculable.

———————————————————————-

What Is Alcoholism?

Alcoholism, which is also known as “alcohol dependence syndrome,” is a
disease that is characterized by the following elements:

• Craving: A strong need, or compulsion, to
  drink.
• Loss of control: The frequent inability to stop
  drinking once a person has begun.
• Physical dependence: The occurrence of withdrawal
  symptoms, such as nausea, sweating, shakiness, and anxiety, when
  alcohol use is stopped after a period of heavy drinking. These symptoms
  are usually relieved by drinking alcohol or by taking another sedative
  drug.
• Tolerance: The need for increasing amounts of
  alcohol in order to get “high.”

Alcoholism has little to do with what kind of alcohol one drinks, how
long one has been drinking, or even exactly how much alcohol one
consumes. But it has a great deal to do with a person’s uncontrollable
need for alcohol. This description of alcoholism helps us understand why
most alcoholics can’t just “use a little willpower” to stop drinking. He
or she is frequently in the grip of a powerful craving for alcohol, a
need that can feel as strong as the need for food or water. While some
people are able to recover without help, the majority of alcoholic
individuals need outside assistance to recover from their disease. With
support and treatment, many individuals are able to stop drinking and
rebuild their lives. Many people wonder: Why can some individuals use
alcohol without problems, while others are utterly unable to control
their drinking? Recent research supported by NIAAA has demonstrated that
for many people, a vulnerability to alcoholism is inherited. Yet it is
important to recognize that aspects of a person’s environment, such as
peer influences and the availability of alcohol, also are significant
influences. Both inherited and environmental influences are called “risk
factors.” But risk is not destiny. Just because alcoholism tends to run
in families doesn’t mean that a child of an alcoholic parent will
automatically develop alcoholism.

———————————————————————-

What Is Alcohol Abuse?

Alcohol abuse differs from alcoholism in that it does not include an
extremely strong craving for alcohol, loss of control, or physical
dependence. In addition, alcohol abuse is less likely than alcoholism to
include tolerance (the need for increasing amounts of alcohol to get
“high”). Alcohol abuse is defined as a pattern of drinking that is
accompanied by one or more of the following situations within a 12-month
period:

• Failure to fulfill major work, school, or home
  responsibilities;
• Drinking in situations that are physically dangerous, such as while
  driving a car or operating machinery;
• Recurring alcohol-related legal problems, such as being arrested
  for driving under the influence of alcohol or for physically hurting
  someone while drunk;
• Continued drinking despite having ongoing relationship problems
  that are caused or worsened by the effects of alcohol.

While alcohol abuse is basically different from alcoholism, it is
important to note that many effects of alcohol abuse are also experienced
by alcoholics.

———————————————————————-

What Are the Signs of a
Problem?

How can you tell whether you, or someone close to you, may have a
drinking problem? Answering the following four questions can help you
find out. (To help remember these questions, note that the first letter
of a key word in each of the four questions spells “CAGE.”)

• Have you ever felt you should Cut down on your drinking?
• Have people Annoyed you by criticizing your drinking?
• Have you ever felt bad or Guilty about your drinking?
• Have you ever had a drink first thing in the morning to steady your
  nerves or to get rid of a hangover (Eye opener)?

One “yes” response suggests a possible alcohol problem. If you
responded “yes” to more than one question, it is highly likely that a
problem exists. In either case, it is important that you see your doctor
or other health care provider right away to discuss your responses to
these questions. He or she can help you determine whether you have a
drinking problem and, if so, recommend the best course of action for
you.

Even if you answered “no” to all of the above questions, if you are
encountering drinking-related problems with your job, relationships,
health, or with the law, you should still seek professional help. The
effects of alcohol abuse can be extremely serious–even fatal–both to
you and to others.

———————————————————————-

The Decision To Get Help

Acknowledging that help is needed for an alcohol problem may not be
easy. But keep in mind that the sooner a person gets help, the better are
his or her chances for a successful recovery.

Any reluctance you may feel about discussing your drinking with your
health care professional may stem from common misconceptions about
alcoholism and alcoholic people. In our society, the myth prevails that
an alcohol problem is somehow a sign of moral weakness. As a result, you
may feel that to seek help is to admit some type of shameful defect in
yourself. In fact, however, alcoholism is a disease that is no more a
sign of weakness than is asthma or diabetes. Moreover, taking steps to
identify a possible drinking problem has an enormous payoff–a chance for
a healthier, more rewarding life.

When you visit your health care provider, he or she will ask you a
number of questions about your alcohol use to determine whether you are
experiencing problems related to your drinking. Try to answer these
questions as fully and honestly as you can. You also will be given a
physical examination. If your health care professional concludes that you
may be dependent on alcohol, he or she may recommend that you see a
specalist in diagnosing and treating alcoholism. You should be involved
in making referral decisions and have all treatment choices explained to
you.

———————————————————————-

Getting Well

Alcoholism Treatment

The nature of treatment depends on the severity of an individual’s
alcoholism and the resources that are available in his or her community.
Treatment may include detoxification (the process of safely getting
alcohol out of one’s system); taking doctor-prescribed medications, such
as disulfiram (Antabuse®) or naltrexone (ReViaTM), to help
prevent a return to drinking once drinking has stopped; and individual
and/or group counseling. There are promising types of counseling that
teach recovering alcoholics to identify situations and feelings that
trigger the urge to drink and to find new ways to cope that do not
include alcohol use. Any of these treatments may be provided in a
hospital or residential treatment setting or on an outpatient basis.

Because the involvement of family members is important to the recovery
process, many programs also offer brief marital counseling and family
therapy as part of the treatment process. Some programs also link up
individuals with vital community resources, such as legal assistance, job
training, child care, and parenting classes.

Alcoholics Anonymous

Virtually all alcoholism treatment programs also include meetings of
Alcoholics Anonymous (AA), which describes itself as a “worldwide
fellowship of men and women who help each other to stay sober.” While AA
is generally recognized as an effective mutual help program for
recovering alcoholics, not everyone responds to AA’s style and message,
and other recovery approaches are available. Even those who are helped by
AA usually find that AA works best in combination with other elements of
treatment, including counseling and medical care.

Can Alcoholism Be Cured?

While alcoholism is a treatable disease, a cure is not yet available.
That means that even if an alcoholic has been sober for a long while and
has regained health, he or she remains susceptible to relapse and must
continue to avoid all alcoholic beverages. “Cutting down” on drinking
doesn’t work; cutting out alcohol is necessary for a successful
recovery.

However, even individuals who are determined to stay sober may suffer
one or several “slips,” or relapses, before achieving long-term sobriety.
Relapses are very common and do not mean that a person has failed or
cannot eventually recover from alcoholism. Keep in mind, too, that every
day that a recovering alcoholic has stayed sober prior to a relapse is
extremely valuable time, both to the individual and to his or her family.
If a relapse occurs, it is very important to try to stop drinking once
again and to get whatever additional support is needed to abstain from
drinking.

Help for Alcohol Abuse

If your health care provider determines that you are not alcohol
dependent but are nonetheless involved in a pattern of alcohol abuse, he
or she can help you:

• Examine the benefits of stopping an unhealthy drinking
  pattern.
• Set a drinking goal for yourself. Some people choose to abstain
  from alcohol, while others prefer to limit the amount they drink.
• Examine the situations that trigger your unhealthy drinking
  patterns, and develop new ways of handling those situations so that you
  can maintain your drinking goal.

Some individuals who have stopped drinking after experiencing
alcohol-related problems choose to attend AA meetings for information and
support, even though they have not been diagnosed as alcoholic.

———————————————————————-

New Directions

With the support of NIAAA, scientists at medical centers and
universities throughout the country are studying alcoholism. The goal of
this research is to develop more effective ways of treating and
preventing alcohol problems. Today, NIAAA funds approximately 90 percent
of all alcoholism research in the United States. Some of the more
exciting investigations include:

• Genetic research: Scientists are now studying
  3,000 individuals from several hundred families with a history of
  alcoholism in order to pinpoint the location of genes that influence
  vulnerability to alcoholism. This new knowledge will help identify
  individuals at high risk for alcoholism and also will pave the way for
  the development of new treatments for alcohol-related problems. Other
  research is investigating the ways in which genetic and environmental
  factors combine to cause alcoholism.
• Treatment approaches: NIAAA also sponsored a study
  called Project MATCH, which tested whether treatment outcome could be
  improved by matching patients to three types of treatment based on
  particular individual characteristics. This study found that all three
  types of treatment reduced drinking markedly in the year following
  treatment.
• New medications: Studies supported by NIAAA have
  led to the Food and Drug Administration’s approval of the medication
  naltrexone (ReViaTM) for the treatment of alcoholism. When used in
  combination with counseling, this prescription drug lessens the craving
  for alcohol in many people and helps prevent a return to heavy
  drinking. Naltrexone is the first medication approved in 45 years to
  help alcoholics stay sober after they detoxify from alcohol.

In addition to these efforts, NIAAA is sponsoring promising research
in other vital areas, such as fetal alcohol syndrome, alcohol’s effects
on the brain and other organs, aspects of drinkers’ environments that may
contribute to alcohol abuse and alcoholism, strategies to reduce
alcohol-related problems, and new treatment techniques. Together, these
investigations will help to prevent alcohol problems; identify alcohol
abuse and alcoholism at earlier stages; and make available new, more
effective treatment approaches for individuals and families.

———————————————————————-

Resources

For more information on alcohol abuse and alcoholism, contact the
following organizations:

Al-Anon Family Group Headquarters
1600 Corporate Landing Parkway
Virginia Beach, VA 23454-5617
Internet address: http://www.al-anon.alateen.org

Makes referrals to local Al-Anon groups, which are support groups for
spouses and other significant adults in an alcoholic person’s life. Also
makes referrals to Alateen groups, which offer support to children of
alcoholics.

Locations of Al-Anon or Alateen meetings worldwide can be obtained by
calling the toll-free numbers Monday through Friday, 8 a.m.-6 p.m.
(e.s.t.):

U. S.: (800) 344-2666
Canada: (800) 443-4525

Free informational materials can be obtained by calling the toll-free
numbers (operating 7 days a week, 24 hours per day):

U. S.: (800) 356-9996
Canada: (800) 714-7498

Alcoholics Anonymous (AA) World Services
475 Riverside Drive, 11th Floor
New York, NY 10115
(212) 870-3400
Internet address: http://www.alcoholics-anonymous.org

Makes referrals to local AA groups and provides informational
materials on the AA program. Many cities and towns also have a local AA
office listed in the telephone book.

National Council on Alcoholism and Drug Dependence
(NCADD)
12 West 21st Street
New York, NY 10010
(800) NCA-CALL
Internet address: http://www.ncadd.com

Provides phone numbers of local NCADD affiliates (who can provide
information on local treatment resources) and educational materials on
alcoholism via the above toll-free number.

National Institute on Alcohol Abuse and
Alcoholism
Scientific Communications Branch
6000 Executive Boulevard, Suite 409
Bethesda, MD 20892-7003
(301) 443-3860
Internet address: http://www.niaaa.nih.gov

Makes available free informational materials on all aspects of
alcoholism, including the effects of drinking during pregnancy, alcohol
use and the elderly, and help for cutting down on drinking.

Prepared: November 1996

Alcohol Sales Climb During Recession
1/16/2002

As Americans face tougher times from a slowing economy, they are
consuming more alcohol, Reuters reported Jan. 12.

“People are drinking more, because people tend to drink more during
tough times,” said JP Morgan beverage analyst John Faucher. “That fits
into the current environment, both from a September 11 standpoint as well
as from an economic standpoint.”

Typically, sales of alcohol increase during recessions. According to
industry figures, spending on liquor has risen in recent months. Data
also shows that more people are consuming alcohol at home rather than in
restaurants.

“I would agree with the theory that people have been drinking more,”
said Davenport & Co. analyst Ann Gurkin, who follows a number of
beverage companies.

Industry watchers also note that consumers are buying “top-shelf”
liquors. Marketers speculate that people are trying to give themselves a
relatively low-priced luxury like a single malt Scotch or bottle of
champagne, while foregoing a vacation or a new car.

“People continue to trade up for the most part,” said Gray Ottley of
Silver Creek Distillers.

See Article

State lawmakers in Ohio want to cut the number of repeat drunk drivers on the road and reduce alcohol related accidents and highway deaths. Ohio Highway Patrol statistics show a high number of accidents involving drunk drivers with previous DUI convictions, and their blood alcohol content results were well above the legal limit.

Ohio Senate Bill 17 would require those with two or more drunk driving convictions to submit to a blood or breath test to determine blood alcohol content (BAC). This would close a current legal loophole that allows motorists to refuse such tests and potentially avoid prosecution. A person found guilty of at least two Ohio DUI arrests in a six-year period would have their car impounded and their license suspended for at least a year. The Ohio Department of Public Safety would be required to maintain a registry of DUI offenders who have been arrested five or more times in the previous 20 years. This information would be made available to the public. A driver with three or more DUI convictions would be required to install an ignition interlock device.

The proposed legislation includes efforts to rehabilitate chronic alcohol abusers, such as mandatory alcohol treatment classes and use of alcohol monitoring devices to detect alcohol consumption.

Some of the measures outlined in SB17 are already at the disposal of the courts though the new law allows the penalties to be applied at an earlier point. The bill is currently being debated in the Senate. It must also go through the House before it could find its way to the governor.